abstract
Neck and back pains are features of life worldwide. Few with spinal pain (SP) have serious
medical (non-spinal) conditions; significant spinal pathology; or compression of root or
cord such as to require surgery. Although the causes of most episodes of SP remain unclear
in practice, physical stress and its consequences on discs, facet joints and supporting soft
tissue structures at work or leisure activities are thought to trigger many initial attacks. But
prognosis usually depends on psychosocial issues. A minority of episodes are prolonged,
intractable and disabling, contributing to the high cost for society. Around 10% of those
presenting to a rheumatological service have non-spinal conditions. There is good evidence
to support prevention of SP through primary, secondary and tertiary routes.
Modern management of chronic SP emphasises the role of self-care, which should
begin in general practice at presentation of the first episode and be reinforced by all health
professionals. In the absence of root compression, bed rest should be minimal. A positive
approach is encouraged, acknowledging that returning to a normal life may require
working through pain. More emphasis is laid on actively encouraging a return to physical
fitness and other activities, including employment. Medication plays a secondary role by
facilitating these objectives.